Provider Demographics
NPI:1699005561
Name:HERZOG UPTOWN PLLC
Entity Type:Organization
Organization Name:HERZOG UPTOWN PLLC
Other - Org Name:FLOSS UPTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:STICKANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-969-1000
Mailing Address - Street 1:2305 CEDAR SPRINGS RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-1854
Mailing Address - Country:US
Mailing Address - Phone:214-969-1000
Mailing Address - Fax:214-969-1001
Practice Address - Street 1:2305 CEDAR SPRINGS RD
Practice Address - Street 2:SUITE 110
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-1854
Practice Address - Country:US
Practice Address - Phone:214-969-1000
Practice Address - Fax:214-969-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-28
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty